Tag: #UHC

Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC Commercial and Exchange Plans: update to Radiology Prior Auth List

Posted on by KR2Medical Billing

As of December 1,2021 the following codes will be added to the radiology prior authorization list. These codes will require an authorization for DOS 12/01/2021 and thereafter.

The prior authorization for these codes WILL NOT APPLY TO The following situations: if the advanced imaging is done in-

  • Emergency room
  • Urgent care center
  • Observation unit
  • Inpatient stay

In case you missed it:

In June 2021, UHC also added more Radiology and Cardiology codes on the Prior Authorization List. These codes apply to UnitedHealthCare Community Plan, Medicare Advantage, commercial and exchange Plans

For complete details on the radiology protocol, refer to the current UnitedHealthcare Administrative Guide

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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC: Payment for COVID-19 testing coverage, outpatient SNF

Posted on by KR2Medical Billing

Previously, UHC would not reimburse for COVID-19 testing when done outside of a skilled inpatient stay at a SNF.

However, during the PHE, starting Jan 27,2020 and then renewed on April 21,2021, subject to further extension, UHC is going to pay for the COVID-19 testing that is done outside of the skilled inpatient stay at a SNF.

This change applies to the following Medicare Advantage Plans:

  • Medicare Advantage Plans
  • Dual Eligible Special Needs Plans (DSNP)
  • Chronic Special Needs Plans (CSNP)
  • UnitedHealthcare Assisted Living Plans (IE-SNP)
  • FIDE/MMP Plans

Plans that this change DOES NOT APPLY TO:

  • UnitedHealthcare Nursing Home Plans (ISNP)
  • UnitedHealthcare commercial plans
  • UnitedHealthcare Community Plans (Medicaid Only Plans)

UHC will re-process the claims, there is no further action needed.

UHC will reprocess claims previously paid at $0 to be reimbursed at 100% of the Medicare fee schedule. No action is required from affected SNFs for these adjustments.

The following codes are going be reimbursed at 100% of Medicare Fee Schedule:

Reminder!

COVID-19 testing performed during an approved skilled stay are subject to Centers for Medicare and Medicaid Services (CMS) consolidated billing rules and are not separately reimbursable, except for the UnitedHealthcare Nursing Home Plan (ISNP). New applicable CMS covered COVID-19 testing codes may be added periodically. We may add or remove codes from the following list, in accordance with CMS coverage guidelines.

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Posted in #unitedhealthcare, Training, Updates

UHC: Genetic testing for hereditary cancer-11 codes that are not covered

Posted on by KR2Medical Billing

Ordering Genetic Testing for your patients? Avoid the costly and unnecessary denials with the most up to date medical coding and medical billing guideline information. Below please find the updated information regarding UHC Genetic testing for hereditary cancer information.

There are 11 codes that were added to the list of non-covered, experimental/investigational list.

These codes will be denied, no matter the prior authorization status, as the Genetic Testing for Hereditary Cancer medical policy states, “genetic testing for BRCA1 and BRCA2 or Multi-Gene hereditary panels with RNA testing is unproven.”

The changes are applied to both Commercial and Medicaid Plans.

UHC Commercial Medical Policy. To visit the full policy please click here.
UHC Community Health (Medicaid)Medical Policy. For the full medical policy, please click here.

Partial List of non covered codes:

For the full list of noncovered codes please click here.

This change does not affect other BRCA1 testing, BRCA2 testing or multi-gene hereditary cancer panels, which will continue to require prior authorization.

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